Oral Medicine V - Brennan's Bespoken Bane Flashcards Preview

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Flashcards in Oral Medicine V - Brennan's Bespoken Bane Deck (116):
1

Dyskinesias affect the jaw

(Levodopa)

True

2

What is the ideal pre-Tx drug regimen for Parkinson's pts?

Take meds 60-90 minutes prior to appt

*peak response period

**also, brief visits

3

Palpitations:

A-fib

(atrial fibrillation)

4

An estimated 2.6 million Americans have A-fib, number is increasing, and is responsible for ______% of all Strokes

15-20%

5

4 comorbidities to A-fib

Coronary artery disease

CHF

Diabetes

Thyrotoxicosis

6

3 Therapies for A-fib

Meds (Antithrombotics, combo, alternative)

Cardioversion

Ablation

7

New Comparative Study, Tx of CVA can be safely administered w/in what time period?

As long as what?

A few weeks of CVA

Kept under optimal medical surveillance

8

Most common Inherited Clotting Disorder:

Hemophilia A

(1 in 5,000 male births)

Hemophilia B

(1 in 30,000 male births)

9

Hemophilia A is a Factor ___ deficiency (80%)

Hemophilia B is a Factor _____ deficiency (13%)

6% is a factor ____ deficiency

Factor VIII

Factor IX

Factor XI

10

Vitamin K rich foods are

Green

11

If you lack one coagulating factor it is...

If you lack multiple coagulating factors it is....

Inherited disorder

Acquired disorder

12

4 Vitamin K factors made in the LIVER:

II

VII

IX

X

13

Factor XII, XI, IX

Factor VII

Intrinsic system/Tissue Factor pathway

Extrinsic system/Contact pathway

14

3 lab tests for Coagulation Disorders

aPTT - Activated Partial Thromboplastin Time

PT - Prothrombin Time

Platelet Count

15

aPTT tests the ______ system. What 4 factors?

PT tests the _______ system. What 5 factors?

Platelet Count deals w/ primary _____

Intrinsic VIII, IX, XI, XII

Extrinsic VII, V, X, prothrombin II, fibrinogen I

Hemostasis

16

Some pts might not be forthcoming about bleeding disorders - what is an important question to ask?

Do you bleed or bruise easily?

17

5 Uses for Warfarin

*what 2 have higher anticoagulation and higher risk of morbidity

Prosthetic Heart valves

Hx deep venous thrombosis

MI

Stroke

Atrial Fibrillation

18

What INR and PT levels would you not worry about (discontinuation not necessary for minor OS)

INR < 3.5

PT < 20 seconds

19

Primary concern for pts on Warfarin:

Physician Consult?

Recourse for excessive bleeding:

Post Op:

Hemostasis

Order/review lab values - perioperative change likely

GelFoam/thrombin, bone wax, Amicar/Tranexamic acid rinses

Acetominophen/codeine

20

PT < 20 seconds, INR < 3.5
These measurements should be takend w/in _____

You can make changes to anticoagulation therapy

24 hrs

False

21

3 Issues w/ Warfarin:

Narrow therapeutic window

Frequent monitoring

Food/Drug interactions

22

What consumables increase the effects of Warfarin?

What decreases?

Wine, cranberries

Green, Vitamin K rich foods

23

Pain med interactions w/ Warfarin:

Abx interactions:

ASA, NSAIDS, Acetaminophen

Tetracycline, ampicillin, amoxicillin/clavulanic acid (augmentin)

24

What Abx should you take w/ pt on Warfarin? (2)

Pen V or Clindamycin

25

T/F
Lit supports altering anticoagulant regimen prior to dental procedures and surgery

False

*go by 3.5 rule

26

Clinical judgement, experience, training, and accessibility to appropriate bleeding management strategies are all important components in any treatment decision

Frame and put on wall

27

3 Antiplatelet agents:

ASA (and NSAIDS)

Ticlid

Plavix

28

Antiplatelets are used primarily for prophylaxis of:

Secondary prevention of adverse ________

in pts with Hx of _______, _______, and ______

Coronary Thrombosis

Thromboembolic events

Coronary thrombosis, Stroke, Unstable Angina

29

Do NOT mix up coagulation factors w/ Anti-Platelets - What does INR measure?

Coagulation (warfarin)

NOT platelets (ASA, etc)

30

Best test for ASA platelet effect is PFA 100 or Ivy bleeding time

Not a problem unless Bleeding time is greater than ______

True

20 minutes

31

NSAIDS will increase bleeding time how?

Generally you must wait 3 half lives (w/ wide variance between drugs)

Antiplatelet

True

32

6 ways to increase clinical risk of bleeding through antiplatelet activity:

ASA

NSAIDS

EtOH

Age

Liver disease

existing coagulopathies

33

Clinical recommendation for pts on Antiplatelet therapies:

Little/No indication to interrupt antiplatelet drugs for dental procedures

34

It is not necessary to interrupt low dose aspirin therapy for simple dental extractions

True

*really any ASA dose

35

Drug Eluting Stents (DES) is often clopidogrel, plavix, etc and when combined with ASA...

Decreases cardiac events after stenting

36

DES, premature discontinuation of antiplatelet therapy greatly increases the risk of what 3 things?

Stent Thrombosis

MI

Death

37

DES usually has ASA/Plavix dual Tx for how long after Stent placed?

Postpone Elective surgery for how long?

If surgery cannot be deferred, what do?

12 months

12 months

continue ASA perioperatively

38

3 reasons for Warfarin replacement drugs:

Wide therapeutic index

Few Drug/Food interactions

Predictable anticoagulant response at fixed doses

39

3 new oral Anticoagulants (Warfarin replacements)

Dabigatran

Rivaroxaban

Apixaban

40

New oral Anticoagulants (Xarelto, etc) have what major flaw

No reversal agent

41

What is the reversal agent for Warfarin?

New drugs?

Vitamin K

nothing

42

If pt taking new Anticoagulants, what 3 lab tests do you need prior to surgery?

aPTT

TT

anti-factor Xa

43

Warfarin acts on what 4 clotting factors:

Unfractioned Heparin on what 2:

Rivaroxaban (and Apixaban):

Dabigatran:

VIIa, IXa, Xa, Thrombin

Xa, Thrombin

Xa

Thrombin

44

2 new drugs act on Factor X:

1 new acts on Factor II (Thrombin):

Rivaroxaban, Apixaban

Dabigatran

45

T/F
It does not appear Dabigatran discontinuation is necessary (if renal function, etc ok)

True

46

Type 1 diabetics have a deficiency of insulin secondary to destruction of what cells?

Type II is either faulty receptors to insulin or antibodies to those insulin receptors or insulin itself

In either case, what is the result?

Beta cells

True

Hyperglycemic State

47

Hyperglycemia, short term polyphagia, polyuria, polydipsia, ketoacitosis/hyperosmotic coma

What is the long-term consequence?

Microangiopathy

*and deposition, delayed healing, infection

48

Diabetes Diagnosis, blood Glucose:

HbA1c must be what in well-controlled diabetics:

>126 mg/100mL

<7%

49

Xerostomia, Infection, poor wound healing, increased perio/caries, etc

Diabetes

50

There is a significant bleeding risk in Diabetes

False

51

Epinepherine concern in Diabetes:

epi in LA increases blood Glucose

52

Well-controlled diabetics can tolerate dental care _____

If cardiac complications...

normally

precautions

53

Diabetes: Morning appts, pts eat normally. Have what to monitor?

What in case of hypoglycemia?

Glucometer

fast-acting carbs

54

In uncontrolled diabetes, provide what care only?

Emergency

55

Controlled diabetics Abx

Uncontrolled:

like everybody else

heightened risk for Infection (Use post-op Abx)

56

Normal thyroid feels...

Enlarged feels...

rubbery

soft

57

If untreated Hyperthyroidism, avoid...

If untreated Hypothyroidism, avoid...

Epi

CNS depressants

58

Hydrocortisone (100-300 mg), CPR, IV glucose Tx for crisis in both Hyper and HypoThyroid

True

59

In well-controlled thyroid disease, Tx infections normally

True

60

Osteoporosis of alveolar bone, caries, etc

Cretinism, enlarged tongue, etc

Pain to ear, jaw, occiput, dysphagia, enlarged, firm nodular, and tender thyroid

Thyrotoxosis

Hypothyroidism

Thyroiditis

61

Possible labe tests for organ transplantation Bleeding time:

liver disease:

renal disease:

platelet count, WBC count, hematocrit

AST, ALT, alkaline phosphatase, PT, bilirubin

creatinine, BUN, specific gravity urine, proteins in urine, hematocrit, WBC, pTT

62

3 important factors in Dentistry to consider in pts w/ transplants:

bleeding

infection

build-up drugs/toxic metabolites (liver/kidney)

63

Oral signs of Immunosuppression include HSV, apthous, CMV, candidiasis...

Mucositis

64

Bone Marrow suppression drug that Increases chance for infection:

affects liver/kidney, causes gingival hyperplasia

Azathiprine

Cyclosporine

65

Avoid dental care Tx for how long after a Transplant?

6 months

66

Pre-transplant Tx

Med consult

prophy Abx, other mods, labs

67

4 Drugs to Increase Interval/Change after Organ Transplant

Acetaminophen

Penicillin V

Cephalexin

Tetracycline (or Doxy)

68

If Abx prophylaxis, give what ideally?

plus...

If allergic?

or Impenem, dosage:

Can't take orally:

plus...

What shouldn't be used in Organ Transplant pts b/c of acute Liver Toxicity?

Amoxicillin, 2g orally 1 hr prior

500 mg oral 1 hr prior

Vancomycin, 1g IV infused slowly over 1 hr prior

1g IV infused 1hr infused slowly prior

Apicillin, 2g IV 1 hr prior

metronidazole 500 mg IV 1 hr prior

Clindamycin

69

Transplant issues, anticoagulation via meds, rejection

Stress - may need steroid supplementation if adrenal suppression

Mucositis, viral infection, aphthous, etc

True

70

Blood Glc reading = 65

Tx w/ fast acting carbs

71

Post-op Abx in Diabetes:

only for Uncontrolled

72

Uncontrolled Diabetic Cardiac Guidelines:

None

*no subset here, follow Cardiac Guidelines

73

Fasting Glucose threshold for Diabetes:

126 mg/100 mL

74

If pt on ASA, what lab test prior to Extraction?

None

*nothing for Anti-platelets!!!

75

Warfarin affects what clotting factors (number and name):

VIIa (tissue factor)
IXa
Xa
IIa (Thrombin)

76

Extrinsic, Tissue Factor pathway, what Factor?

VII

77

Med Consult during Chemo?

Postpone when Platelets below...

or Neutrophils below...

Always

50,000

1,000 mm3

78

Tx of Uncontrolled Diabetics when?

only during Emergency

79

Parkinson's, take meds _-_ minuted prior and keep brief

60-90 minutes prior

80

Old research on stroke, wait....

New research, Tx w/in ____ as long as surveilled

6 months

a few weeks

81

4 Vitamin K dependent factors:

II, VII, IX, X

*warfarin

82

Clotting factor II:

IIa:

I:

Ia:

Prothrombin

Thrombin

Fibrinogen

Fibrin

83

If on Warfarin, INR <

PT <

Should be measured w/in

3.5

20 sec

24 hrs

84

New drug, Thrombin inhibitor:

3 Factor Xa inhibitors:

Dabigatran (Pradaxa)

Rivaroxaban, Apixaban, Edoxaban

85

2 Abx ok to use w/ Warfarin:

PenV

Clindamycin

86

Asthma, instruct pt to bring Inhaler, consider _____ if severe.

Emergency, use...

pulse ox during Tx

Ventolin/Proventil (short acting beta 2 adrenergic)

87

COPD 4 clinical considerations:

Stability of pt

chair position

avoid Rubber Dam

Low-flow supplemental Oxygen

88

Almost everyone w/ Asthma has what Drug Allergy?

ASA

89

Chronic Bronchitis, chronic cough w/ sputum production for what time period?

3 consecutive months

2 successive years

90

Hypercapnea

too much CO2 (COPD)

91

Theophylline:

COPD (Stevens-Johnson syndrome)

92

Unstable COPD pt (below 91% Oxygen) must have what 2 mods?

Upright

Pulse ox

93

Stable COPD, ok to use diazepam

must be upright

True

True

94

Early stage tumors:

Advanced stage:

surgery

chemoradiotherapy

95

Pre-cancer oral health exam should be done when?

1 month prior cancer Tx

96

Common radiation side-effect

Trismus

*difficulty opening

97

Radiation Therapy, dental procedures should be done how long prior?

If ortho bands

fabricate...

Endo in field:

Endo out of field:

avoid removables, fabricate dentures _____ post surgery/radiation

10-14 (idally 21) to heal

remove

custom gel-applicator

Extract, no re-treats

RCT can be done

3-4 months

98

If chemo, ask Oncologist cancer, stage, palliative/curative, prognosis

blood:

clotting factors:

Tx schedule (so safe dental Tx can be delivered)

True

CBC, neutrophil, platelet

if invasive

true

99

If possible, all dental Tx should be done ___ prior to Chemo

Extractions should be done how long prior ideally?

minimum?

1 week

3 weeks

10-14 days

100

When do you need a Med Consult if pt on Chemo?

Always

*even prophys

101

If pt on Chemo, when would you postpone Tx? (2 cases)

platelet count < 50,000

neutrophil count < 1,000

102

When would you schedule a Chemo pt?

17-20 days post Tx (when they feel best)

103

Hematopoietic stem cell transplantation:

Intentional destruction of Marrow

stem cell transplant

104

3 types of Hematopeitic Stem cell transplants

Autologous (own cells)

Allogenic (own species)

Syngeneic (identical twin)

105

HSCT similar guidelines to Chemo

True

106

HSCT, delay elective procedures for how long?

Greatest risk of complications:

1 year

100 days

107

*180 days autologous, 365 allogeneic for standard care

True

108

Painful, ulcerative oral complication of Radiation

Oral Mucositis

109

Mucositis, xerostomia, candidiasis, osteoradionecrosis,
Trismus

Radiation

110

Mucositis, ural ulceration, anemia, thrombocytopenia, infection, neurotoxicity, osteonecrosis of the jaw, xerostomia

Chemotherapy

111

Anticonvulsants can modify the pathologic process and decrease orofacial pain

True

112

HSCT prevalence of Oral Complications:

80%

*severe immunosuppression

113

GVHD manifests orally as atrophy, erythema, white striations, plaques (similar to lichen planus), xerostomia, taste changes, formation of mucoceles, and mucosal sclerosis

True

114

If neutrophil count is below 50,000, what is needed

Abx prophylaxis

115

All procedures 1 week prior to chemo

17-20 days post

True

116

If Controlled Diabetes what might you need to do prior to Tx

current HbA1c

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